[Diagnostic significance of human papillomavirus overestimated]

Human papillomavirus (HPV) is a group of oncogenic viruses, of which some are known to cause cervical cancer in women. The causal relation between infection and cervical cancer is well established. There is however a discrepancy between the rate of infection and the incidence of (pre)neoplastic lesions of the cervix. Cohort studies of the natural history of this virus show that many, if not most, young females become infected, but that the infection usually clears without any consequences. This high infection rate precludes the use of HPV diagnosis for primary screening for cervical cancer. The low specificity precludes its use for triage of borderline cervical lesions. Critical appraisal of different diagnostic approaches using a direct or indirect molecular detection method of HPV does not show a convincing advantage over 'conservative' diagnostic cytological regiments. Perhaps the absence of the virus is more significant than its presence.